Form

Stephenson School PTA Membership Form 2011-12
First name:*
Last name:*
Address:*
City/State/Zip:*
E-mail:*
Phone:*
Membership Type:*
Name of your child/children attending Stephenson and their teacher.
Child 1 First Name:
Child 1 Last Name:
Child 1's Teacher:
Child 2 First Name:
Child 2 Last Name:
Child 2's Teacher:
Child 3 First Name:
Child 3 Last Name:
Chid 3's Teacher:
Child 4 First Name:
Child 4 Last Name:
Child 4's Teacher:
Additional Memberships in the same household - $15 per person.
Add 1 First Name:
Add 1 Last Name:
Membership Type:
Add 2 First Name:
Add 2 Last Name:
Membership Type:
One parent and Student Directory is included with each primary membership. Additional directories may be purchased for $5 each.
Number of Additional Directories
(In order to make payment for your membership, you must click the options below that correspond to your membership and directory choices above.)
PTA Membership*
Membership Dues $35.00 USD
Additional Membership $15.00 USD
Additional Membership $15.00 USD
Additional Membership $15.00 USD
Additional Directory $5.00 USD
Additional Directory $5.00 USD
Additional Directory $5.00 USD
Teacher/Staff Membership $10.00 USD

Total: $0.00 USD
Can your information be included in the school directory?

Yes No
Thank you for supporting our school!
Stephenson School PTA, as an affiliated constituent of Oregon PTA, pledges that membership in PTA shall be open, without discrimination, to anyone who believes in and supports the mission and purposes of National PTA. National PTA Unit ID: 00016897, Region 2. 3/4/2009
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Stephenson School PTA Membership Form 2011-12

Thank you for supporting our school!